Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dallas Lee Domangue, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1205413010

Dallas Lee Domangue, MD is an Anesthesiology in Jackson, Mississippi. Graduated from Louisiana State University School of Medicine in New Orleans in 2021, 5 years ago. Practices with Thibodaux Regional Network Development Corporation, a 135-clinician group and accepts Medicare assignment. Licensed in Mississippi.

Years since qualifying
5
Trained at
Louisiana State University School of Medicine in New Orleans
Licensed in
MS
In the registry since
2021
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

2500 N State St
Jackson, MS 39216-4500
Phone: (601) 984-1000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Anesthesiology Physician (primary) Taxonomy 207L00000X · Licence T-4248 (MS)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1205413010
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMarch 26, 2021
Last updated in NPPESJuly 3, 2021
Certification dateJuly 3, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyANESTHESIOLOGY
Medical schoolLOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN NEW ORLEANS
Graduated 2021 (5 years in practice)
Group practice Thibodaux Regional Network Development Corporation — 135 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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